Glantz vs. Burstyn – hardly a fair fight

by Carl V Phillips

Ok, I am giving in to all the lobbying I have gotten to respond to Stanton Glantz’s inane attack on the Burstyn study.  I will call it my Sunday Science Lesson for the week.

I am not going to bother to submit at Glantz’s page because though Glantz makes is page look like a blog, it really isn’t — he censors out any comments he does not like.  (That, of course, is not true here — he or anyone who agrees with him is free to respond in the comments without fear of censorship.)  Indeed, at the time of this writing the only comment allowed, despite several readers of this blog reporting that they wrote comments, was one by a clueless supporter of Glantz who clearly did not even read the paper (I am not addressing that, but it is addressed by Konstantinos Farsalinos here).

[UPDATE: Not too long after this post was published, several comments submitted on Glantz’s post that had already been posted in comments in this blog but had not been left unapproved by him for days were allowed to post.  Funny that.]

I am pretty sure that Prof Burstyn is not going to be interested[*] in wandering over to see the ramblings of Glantz and other anti-scientific extremists, so this will also serve the purpose of letting him know what was claimed.

[*The passage from Alice’s Adventures in Wonderland comes to mind:

“But I don’t want to go among mad people,” Alice remarked.  “Oh you can’t help that,” said the Cat. “We’re all mad here. I’m mad. You’re mad.” “How do you know I am mad?” said Alice. “You must be,” said the Cat, “or you wouldn’t have come here.”  ]

My first observation is that Glantz’s attack serves as  a testimonial that he recognizes that Burstyn’s paper is important and a threat to anti-scientific lies about e-cigarettes.  Glantz responded about four hours after the paper became available — not really enough time to seriously read a new paper, let alone think through how to comment on it.  This was a clear example of panic.  The panic was not about the study being used in advocacy or showing up in newspapers — that will happen slowly, over the course of months or years, so there would be no need to hurry.

No, it was quite clear that he was panicked about the ANTZ’s useful idiots hearing about it and possibly learning something their puppet masters did not want them to know.  I am talking about the people working in county public health departments, GP medics, etc., who genuinely care about health and thus would support THR if they knew the facts, but whose misplaced trust has made them victims of the anti-THR liars like Glantz.  If they heard about this before they could be pre-propoagandized, they might learn something.  So Glantz’s junk response was rushed out through the (not-entirely-secret) secret communication channels that are used to keep the useful idiots in line.

(For those who do not know, the ANTZ mostly communicate through these secret channels, in contrast with the behavior of truth-seeking or public-interested advocates, who communicate openly.  They do this because (a) they know that if the made their claims in the light of day, their lies would be ripped to shreds and their useful idiots might rebel and (b) like most political (i.e., not truth-seeking) groups, they like to create the illusion of a consensus by instructing hundreds of seemingly unrelated people to “spontaneously” make the same observations to the press, hiding the fact that this is really just a few thousand people trying to look like they are a broad political movement.)

So, I award one point to Burstyn for Glantz’s panicked reaction.

Skipping first to the end, and Glantz’s only substantive claim in his attack:

The analysis also ignores the high levels of ulttrafine particles e-cigs generate that can trigger inflammatory processes and trigger heart attacks and respiratory problems.

This is actually LOL funny if you are enough of a geek.  Those two links (in the original, of course) are to fairly arcane statistical analyses of epidemiologic data, so they cannot actually tell us anything about mechanisms (like inflammatory processes), only observable population outcomes.  However, if Glantz were not so averse to using honest science, he actually could have actually supported this claim using relevant evidence about the tissue effects that has been done by tobacco companies (example).  But his citations and all the research that actually supports his claims are about the effect of combustion products.

The lung and heart problems result from solid particles, whereas e-cigarettes produce liquid particles (aka aerosol or droplets) which have entirely different properties.  Some types of small solid particles can lodge deep in the lungs, creating problems over time, or travel into the bloodstream, maintaining their form, and do damage elsewhere.  Small liquid particles do exactly the same things as larger ones in the lungs — they transfer the liquid through the lung (there is nothing to lodge), which is then diluted into the blood (there are no longer any particles).  Indeed, it appears that small droplets are probably better because devices that apparently deliver smaller droplets (e.g., using bigger batteries) seem to be preferred by consumers (though I would expect that in Glantz’s anti-humanitarian view, “preferred by consumers” is a bad thing).

Glantz presumably knows that e-cigarettes produce liquid particles, since it is right there in Burstyn’s paper, as well as being common knowledge about e-cigarettes.  Moreover, Burstyn points out that chemistry studies that have been used to suggest there are inorganic solids in the vapor are misleading, since they do not assess what molecular form the metals were in; he points out that they were most likely dissolved salts (i.e., part of the liquid).  Thus, apparently Glantz’s problem (this is the LOL part if you are geeky enough) is that he does not understand the difference between liquids and solids.  This perhaps explains why he had to leave mechanical engineering (where not knowing the difference between liquids and solids can be rather disastrous) and go into anti-tobacco extremist activism (where it is not such a problem to not know… well, anything).

So, clear point to Burstyn there.

Circling back to his less substantive points, he leads with standard ANTZ drivel:

This paper uses  the same approach to risk assessment that I remember from risk assessments done of secondhand smoke years ago by tobacco industry apologists that concluded that secondhand tobacco smoke could not produce any adverse health effects.

What same approach to risk assessment?  Reviewing studies?  Calculating exposure levels?  Putting exposure levels in a useful perspective?  Basing conclusions on data rather than political goals?  Writing in English?

Of course this paper uses the same approach to risk assessment as other approaches to risk assessment.  Someone with a great deal of experience at doing such research (Burstyn) is going to use the accepted methods (though since he is one of the great epidemiologic thinkers of his generation, I am confident that he used the best of these, and did not blindly follow what is typical).  Someone who does not actually read much (Glantz) is going to notice that these look a lot like the only other risk assessments he has ever looked at.

Notice that Glantz’s statement is designed to make his typical sloppy reader believe that he said “there are elements of this analysis that are similar to Evil Evil Tobacco Company analyses of ETS and different from what is normally done in the analyses that are used to make exposure policy.”  But he does not say that, does he?  (The above quote is everything he says.)  He could have given even a single example of how Burstyn’s analysis had something in common with the studies he denigrates (though notice he does not actually find fault with them) and that differs from those used to make thousands of regulatory decisions about airborne exposures, but he did not.  Presumably he had nothing in mind beyond misleading innuendo.

This is such a stupid claim by Glantz that perhaps it would be too generous to award Burstyn a point for it, but Glantz definitely gets a -1 penalty for it.

Glantz follows that with:

The first problem with this study is that it compares levels of various toxins in e-cigs with threshold limit values (TLVs) which have been published by the American Council of Government Industrial Hygienists using that are generally viewed as not health protective.  In addition, as noted in the report, TLVs are for occupational exposures.  Occupational exposures are generally much higher than levels considered acceptable for ambient or population-level exposures. Occupational exposures also do not consider exposure to sensitive subgroups, such as people with medical conditions, children and infants, who might be exposed to secondhand ecigarette emissions.  Finally, even when setting allowable occupational exposures, regulatory agencies like OSHA often establish tighter standards than TLVs, and often those tighter levels have been criticized as not being health protective.

His basis for that claim about “not health protective”?  Burstyn explained and defended the choice of the TLVs; Glantz tries to trick his readers into believing that Burstyn just made a random choice without justification. Burstyn points out that occupational standards are actually rather conservative (i.e., highly protective) when we are talking about an intentionally-chosen exposure.  We all engage in countless activities that expose us to hazards that, if they were an involuntary hazard that was being forced upon workers in order to be able to keep their jobs, would not be allowed, or at least there would be mandatory mitigation measures imposed.

Glantz’s only basis for this attack appears to be quotes from Wikipedia — I did not notice before that this is what he links to (another LOL moment!).  The rest of that sentence is a close paraphrase of a sentence in the Wikipedia entry (and both the entry and Glantz assert the claim without support).  So Glantz is relying on an unsupported statement by an anonymous author (which might even be himself) of a single line of a general-knowledge encyclopedia.  (For those who may not know, Wikipedia is an excellent source for countless areas of inquiry, but every scientific expert knows that it fails miserably — for fairly obvious reasons — when dealing with controversies in science or science-based policy.)

But setting that aside, let us assume that Glantz genuinely believes there are better standards to compare an exposure to.  Fine.  That almost starts to look like a comment by someone who is actually seeking the truth.  Indeed, in private comments, several reviewers of the paper who are actual peer reviewers (i.e., expert enough to provide useful comments) have suggested that the next version make comparisons to some other standards too, which would show that the conclusions do not depend on the choice of standards (so long as Burstyn avoids absurd standards like an EPA standard for formaldehyde that apparently makes being in the same room as yourself an unacceptable hazard).

But Glantz’s statement only almost looks like that of someone interested in the truth.  Someone who was minimally attempting to seek the truth would have suggested a specific alternative comparison.  He makes a vague allusion to OSHA standards (again, apparently quoting from Wikipedia), but does not actually say “I think this would be better”.  Someone who was both seeking the truth and expert, and trying to be useful, would go so far as to pick one of those alternative standards and compare it to Burstyn’s numbers (a fairly simple exercise).  Even someone lacking the numeracy to be able to do that, but who was interested in the truth, could say something like “if he were to compare the levels to Standard X and still find that they were non-problematic, then I would believe him.”  But of course Glantz did not do any of that, because he already guesses that the answer will not support him, so he does not want to commit to ever believing any science.  He already plans to come up with some other rationalization for ignoring the truth when this one is shown to be wrong.

Notice also that he brings in the chiiiildren.  He implies that Burstyn’s analysis was about ambient and population exposures.  Is he lying to his useful idiots or just incapable of understanding the paper?  We cannot be sure.  But those of us who did understand the paper know that the numbers analyzed are for the exposure to the vaper herself, and that any second-hand exposure is noted to be orders of magnitude smaller still.  That is, the second-hand exposure is not merely well below the TLVs; it is orders of magnitude lower than the numbers that are already well below the TLVs.  Burstyn never tries to compare the exposure of bystanders to TLVs or any other standard because he reports that those exposures are so unimaginably low that it makes no sense.

Burstyn does not make the point that someone who has a medical condition that contraindicates e-cigarette use should not use them, but he does point out that it is a voluntary exposure and the rest obviously goes without saying.  And, of course, Glantz does not identify what conditions he might be talking about, he just vaguely waves his hands because he does not want to get pinned down so that he cannot change his story later.  (I will believe that he actually cares about second-hand exposure — rather than just using it as a rationalization for fighting THR — the day he recommends that smokeless tobacco should be endorsed over e-cigarette use, or even just over smoking.)

So, one point to Burstyn for explaining why occupational standards are actually conservative, a clear victory over Glantz just lifting some vague and unsubstantiated claims from Wikipedia.  One point to Burstyn for pointing out that the second-hand exposures are orders of magnitude less than the vapers’ exposures, a clear victory over Glantz trying to pretend this is not the case.  Because I cannot find anything else that could possibly earn Glantz a point, I am going to take pity and give him one for the very charitable interpretation of this passage as saying “you should probably include comparisons to other published exposure limits in order to make the accuracy of your conclusions more clear.”  However, I am going to penalize him a point for relying on Wikipedia for claims about a scientific controversy, just as I would penalize any undergraduate, let alone graduate student.

Finally, Glantz ends his missive with a random ad hominem attack on me.  This is especially pathetic because, obviously, I am not even an author of the study.  He attacks Burstyn because he mentions me in the acknowledgments.  It is like second-hand ad hominem (1000 times less harmful than the already inconsequential implications of an ad hominem attack).   The content of the attack is basically, “Phillips does not share my irrational hatred of tobacco products and tobacco companies.”  I will take that as a complement.  This is especially the case because I have repeatedly pointed out (and endorsed others pointing this out too; no links because there are too many to track down), based on actual analysis, not ad hominems, how Glantz is both scientifically clueless and dishonest.  And yet the best he can come up with about me, after all that, is that I do not share his irrational hatreds.

Another -1 for Glantz for exposing us to second-hand ad hominem, and even though I am not actually in the match, I am going to award myself a point for the fact that he cannot come up with even a single criticism of my analyses.

So the final score:  Burstyn gets a hat trick plus one, and Glantz nets negative one, which puts him behind me, even though I was not even on the pitch.  Come to think of it, it also puts him behind the 7 billion other people who have not entered the conversation at all.